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Utah rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.38 / $50.92 / $105.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $1.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.92 / $2.24 / $2.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39